Organ & Tissue Transplantation Awareness and Recent Updates

Dr Amol KingeRes. Medical Officer

Seth GSMC & KEM Hospital, Mumbai

Outline•What is Organ Donation•Need of organ donation•Types of Organ Donation•Which Organs can be Donated•Concept of brain death•Common conditions leading to brain death•Diagnosis of brain death•Myths related to organ donation•Religious views towards organ donation

Facts…1. Today's date there are 55000

waiting for OD.2. At every 16 minutes, new one is

added to the list.3. 10 die daily from the list without the

organ4. Annually only about 7000 solid

organ transplantations done.5. Kidney-6000,

Liver-1200, Heart-17, Cornea- 25000 (Annually)

Rates of OD-

India- 0.16/million population

USA – 22/million population

Spain- 36/million population

Corneal Blindness very common PROBLEM in India. More than 3 million cases in India. 60% are <12 years age group.

Cornea REQUIRED : 1 lakh / year, Cornea DONATED : 25000 / year

Anatomy of Normal EYE

After CORNEAL TRANSPLANT

What is need?•2.5 Lakh new Kidney disease patient every

year and only 750 benefitted with renal transplant.

•More than 80000 patients suffering from Liver diseases

•50,000 patients dying due to Heart diseases

• India is Diabetes capital (2nd in world)

Situation in INDIA

• Annually 1.6 lakh die due to Road Traffic Accidents.

• 67% deaths: Brain stem death.

• 93000: Potential organ donors / year.

• But in reality, only 0.05 / Lakh people donate their.

• Rate of OD is Highest in Spain (35 per 1 lakh population)

• In India, Tamilnadu ranks first among all states.

Deceased Donors Per Million Population

24.2521.721.6521.5

2018.1

13.1512.96

12.1810.62

6.14.3

2.70.75

0.120.05

33.68

0 5 10 15 20 25 30 35

SpainAustria

PortugalBeligium

USAFrance

ItalyCanada

United KingdomGermanyAustralia

HKSingapore

TaiwanKorea

PhilippinesJapan

de Villa VH, Chen CL, et al. Transplantation 2003; 75:S2 (Modified from)

Great scarcity of the organs

VSWastage

of cadaveric organs

Real Problem

Understanding concept

Identify brain-dead patients

Promote Organ Donation

Solution

Types of Organ Donation•After NATURAL DEATH

• By LIVING RELATED DONOR

•By LIVING UNRELATED DONOR

•After BRAIN STEM DEATH

Which Organs Can be Donated by living donor?

Kidney

Blood

Lungs

Part of liver Liver

Part of Pancreas

Living Donor

Bone marrow

2 eyesLungsHeartLiverPancreasAll Bones & CartilagesBlood vessels2 KidneysIntestineMuscles & ligamentsSkin & FasciaLarynx2 hands20 Fingers

What can donated after BSD?

More than 50 organs can be donated after Brain Stem Death

Organs needed in different conditions

Diseases Organs

Heart Failure Heart

Terminal Lung illnesses Lungs

Kidney failure Kidneys

Liver failure Liver

Diabetes Pancreas

Corneal Blindness Eyes

Heart Valvular disease Heart valve

Severe Burns Skin

Age limit for Organ DonationOrgans Age limit

Kidneys, Liver up-to 70 years

Heart, Lungs up-to 50 years

Pancreas, Intestine up-to 60-65 years

Corneas, skin up-to 100 years

Heart valves up-to 50 years

Bone up-to 70 years

Age limit of Different Organs to Donate

Exclusion Criteria (for Deceased Donor)•Absolute

▫Age>70 Yrs▫Renal disease ▫Malignancy ▫Hypertension & infective heart diseases▫ Intravenous drug abuse ▫Seropositive▫Rabies

•Relative▫Age <6years or >60 years▫Mild Hypertension▫Early Diabetes

Skin Donation

• Life saving for burn patients.

• Makes wound healing FAST.

• Removed using specialized knife and preserved like a roll.

• Taken from un-exposed parts of the body: No Disfigurement.

• SKIN BANK to preserve donated skin.

Concept of Death•Ultimate reality of life•Something fearful and unwanted •No discussion•End point •Clinically cessation of cardio-respiratory

function

Cardio-respiratory Arrest

Complete Cessation Of Breathing And

Circulation

Death

Concept of Brain Stem Death

Common Causes of Brain Death

•Head injury• Intra cerebral

hemorrhage• Ischemic brain

damage•Tumor•Hanging•Drowning

Diagnosis of Brain stem death

(According to Harward criteria)

• Unreceptivity & Unresponsivity

• No Movements / Breathing• No Reflexes• Only in ICU settings• Two independent teams to

declare• Two brain death declarations

with 6 hr interval

Body Donation• Whole body donation is covered by the

Anatomy Act 1984.

• Defined as the “Act of giving only Body after death for Medical Research and Education.” Those donated cadavers remain a principal teaching tool for anatomists and medical educators teaching gross anatomy.

• Bodies are not accepted for teaching purposes if organs have been donated or if there has been a post-mortem examination. 

You can Help by:•A. Becoming a Donor, and talking to

your family about your decision of saving lives of others.

•B. Promoting donation by motivating people at work place, in your community, at your place of worship, and in your civic organizations.

Who will tell me..???Transplant Coordinator and Treating Registered Medical Practitioner will explain you about the process of Transplant.

Transplant CoordinatorCounsel the grieved family

Make them comfortable

Approach the subject of eye donation

solid organ donation

If the family gives consent

Inform the Nodal Officer

HOTA act-1994

•Brain death a Legally Accepted form

•Established criteria for Brain Stem Death Declaration

•Donation only with Consent of next of kin

•Commercial Dealings of such organs are prohibited

Some recent Amendments in LAW

•TOHO (Transplantation of human organs) & Tissue act

•SWAP donation permitted.•Grand parents and grand children included in

Near Relatives.•Waiting Registries: Regional level and State

level•Provision of Appropriate Authority in case of

Donor if Living.

SWAP Donation

•Located at 4th and 5th Floor of Institute of Pathology (ICMR) Building in Safdarjung Hospital New Delhi

Divisions:•"National Human Organ and Tissue

Removal and Storage Network”•"National Biomaterial Centre”.

Zonal Transplant Coordination Committee

• Maintains list of hospitals registered for organs retrieval and transplantation.• Maintains waiting list of patients who are desirous for organs.• carries fair distribution of organs based on waiting list.• waiting list is prepared on the basis of - Age

- Severity of disease- Prognosis/expected survival

after transplant

Organ Retrieving Hospitals

Government control(As per HOTA act-1994)

ZTCC

No hospital can transplant organ without prior information or permission of ZTCC.

Organs Transplanting hospitals

Multi-organs transplant centres

Problems in Promoting Organ Donation

•Religious myths•Professional Ignorance •Apathy to the cause •Shy/afraid of discussing donation •Don’t know –what to do???? •Scared of bad reputation •Fear of litigation •Poor communication

Religious Views: Hinduism•Believe in rebirth of the soul•Body is cremated after death•Human form is the highest in the order of

re-births before the soul reaches the creator

•Sacrifice to the fellow humans considered equivalent to service to god

•Religious laws and scriptures do not prohibit organ donation

LIFE IS AMAZING… PASS IT ON…!!!

Religious Views: Islam•Until early 90s the religious leaders failed

to approve of organ donation•Mid 90s the religious leader in saudi

(Mecca) passed a fatwa, making organ donation after death permissible under islamic law

LIFE IS AMAZING… PASS IT ON…!!!

Religious Views: Christian•Catholics view organ donation as an act of

charity•Ethically and morally acceptable to the

vatican•Pope John Paul ii has given his support to

organ donation•Protestant groups generally endorse organ

donationLIFE IS AMAZING… PASS IT ON…!!!

Overall Religious ViewsAll other major religions such as Sikhism, Buddhism and Jainism do not oppose organ donation and share similar views as that of Hinduism.

Positive Changes

Aishwarya Rai, Amitabh Bachhan, Jaya Bhachhan, Rajnikanth, Amir Khan and many other film

personalities have pledged their Eyes at different times on media

Anil Kumble, Sunil Shetty, Yukta Mukhi, Revathi Menon and Madhavan have endorsed their views on multi-organ donation

Green Corridor

LIFE IS AMAZING… PASS IT ON…!!!

LIFE IS AMAZING… PASS IT ON…!!!

You choose…

LIFE IS AMAZING… PASS IT ON…!!!

You don’t need to be DOCTOR to save LIVES !!!

I am an ORGAN DONOR…Are YOU….???

THANK YOU…